Agreement Between Transesophageal Echocardiographic Tricuspid Annular Plane Systolic Excursion Measurement Methods in...

To assess the agreement between 2-dimensional tricuspid annular plane systolic excursion (2D-TAPSE), 2D-TAPSE-apex, and 2D speckle tracking echocardiography (STE-TAPSE) in a cross-section of routine cardiac surgery patients.

Retrospective, observational study.

Tertiary, academic referral hospital.

Patients undergoing elective cardiac surgery with intraoperative transesophageal echocardiography (TEE) imaging.

TEE imaging was reviewed and evaluated for the following three different measurements of transthoracic echocardiography-TAPSE surrogates: 2D-TAPSE, 2D-TAPSE-apex, and STE-TAPSE. Statistical analyses, including 2-sample t tests, linear regression, and agreement using the Bland-Altman methods, were performed.

Modest correlation was demonstrated between STE-TAPSE and 2D-TAPSE (R² = 0.37; p < 0.001) and between STE-TAPSE and 2D-TAPSE-apex (R² = 0.34; p < 0.001). There was good correlation between 2D-TAPSE and 2D-TAPSE-apex (R² = 0.77, p < 0.001). The Bland-Altman analysis between these methods showed minimal bias: STE-TAPSE and 2D-TAPSE 0.84 mm, STE-TAPSE and 2D-TAPSE-apex 0.14 mm, and 2D-TAPSE and 2D-TAPSE-apex 0.98 mm. However, the agreement was poor, with 95% limits of agreement of -10.67 to 8.99 mm, -10.67 to 10.96 mm, and -4.91 to 6.88 mm, respectively.

Correlation and minimal bias were found between the several proposed TEE surrogates of transthoracic echocardiography-TAPSE; however, there was poor agreement. Therefore, these surrogates are not interchangeable, and each method needs to be separately validated for clinical use to relevant perioperative outcomes.